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Babies lying bottom first or feet first in the uterus (womb) instead of in the usual head first position are called breech babies. At term only 3 to 4 out of 10 babies are found to be in breech position.
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In most cases it is only a matter of chance that a baby does not turn and remains in the breech (bottom down) position. In a few situations, certain factors make it difficult for a baby to turn during pregnancy. These might include the amount of fluid in the womb (either too much or too little), the position of the placenta or the presence of more than one baby. Most breech babies are born healthy.
If there is a case of a breech presentation, you can try to turn the baby. ECV is usually performed after 36 or 37 weeks of pregnancy. However, it can be performed right up until you are in early labour. You should discuss all the options with your obstetrician and follow their recommendations.
External Cephalic version (ECV): This is a non-surgical method of turning a breech baby in the uterus. During the procedure, your gynaecologist will give you medicine to help your uterus relax. Before the ECV you will have a bedside ultrasound to check baby’s heart beat and position and after the ECV it will be done again to check if the baby has turned with head down position. The success rate is around 40% to 50% and depends on the skills of your obstetrician.
ECV can be uncomfortable and painful at times. Your obstetrician will stop if you are experiencing pain. Procedure usually last for few minutes. Fetal heart is monitored for an hour after procedure and you will be advised to go home with follow up plan.
If your blood type is Rhesus D negative- you will be advised to take anti D injection.
There is no scientific evidence, but one may try this technique.
The breech tilt: While lying on your back, use large, firm pillows to raise your hips about a foot off the floor. Do these three times every day for 10–15 minutes. You can do this technique when the baby is active and on an empty stomach.
If your baby remains breech towards the end of pregnancy, you should be given the option of a caesarean section. Research has shown that planned caesarean section is safer for your baby than a vaginal breech.
Your gynaecologist may attempt breech vaginal delivery after discussion with you it in the following situations:
While a successful vaginal birth carries the least risks for you, it carries a small increased risk of your baby dying around the time of delivery. A vaginal breech birth may also cause serious short-term complications for your baby. However, these complications do not seem to have any long-term effects on your baby. Your individual risks should be discussed with you by your gynaecologist.
Consult, best obstetrician and gynaecologist at the CK Birla Hospital in Gurgaon to learn more about this condition and discuss your individual risks. Book your appointment today!
All of us have various kinds of a headaches and in most cases, people treat themselves with basic painkillers, drinking extra water, taking rest or quietly by waiting for the headache to subside on its own. Even so, headaches can be painful, and a cause of worry and they may have a serious underlying cause. In fact, most headaches are troublesome but cause no lasting harm.
Headaches can be primary or secondary. Your doctor can typically tell the cause of your headache by talking to you and examining you carefully. Once he or she has identified the cause then you will be able to determine how to reduce or stop the headaches. This may mean taking medication only when you get the headaches, taking daily medication to avoid them or, sometimes, stopping a medication you are already taking.
Tension headaches
Tension headaches are generally felt as a band or across the forehead. They can be difficult and tiring, but they do not usually disturb sleep. Several people can carry on working with a tension headache. They are not commonly made worse by physical activity. Some people with these type of headaches can be affected by bright light or noise.
Tension headaches tend to get worse as the day goes on and are typically least in the morning. They are typically referred to as pressure headaches. They’ll interrupt work and concentration. However, in most cases, not enough to send you to bed. Tension headaches are caused by tightness within the muscles at the rear of the neck and over the scalp. Tiredness, stress and a clumsy sleeping position will make them worse.
Tension headaches sometimes answer to straightforward painkillers. Changes in lifestyle will facilitate – like having a lot of water, and a smart diet. Often tension headaches will be caused by poor vision, significantly if reading in low light for long periods.
Migraines
A typical migraine is one-sided and resonates. Headaches that are one-sided, headaches that throb and headaches that cause you to feel sick are possibly migraines rather than any other type. Migraines are typically severe enough to be disabling. Some patients have to be compelled to move to bed to get rid of their headache.
Migraines will last sometimes from four hours to 3 days. They are typically made worse by movement or sound. Patients typically feel sick (nausea) or are sick (vomit), notwithstanding the pain isn’t severe. Typically, patients feel bright light makes their headache worse. Most of the people with migraines have 1-2 attacks a month. The warning symptoms will last for up to an hour and are usually followed by a headache.
Cluster headaches
Cluster headaches are terribly severe headaches, generally referred to as ‘suicide headaches. They occur in clusters, typically daily for a number of days or perhaps weeks. Then they disappear for months or finish. They are uncommon and have a tendency to occur significantly in male smokers. Cluster headaches are sometimes one-sided. Patients typically have a red watery eye on the affected face, a stuffy fluid nose and a lax lid.
Chronic daily headaches
Chronic daily headache or chronic headache is typically caused by muscle tension at the back of the neck and affects ladies a lot more than men. Chronic implies that the condition is persistent. These headaches will be started by neck injuries or weariness and turn worse by medication overuse. A headache that happens virtually daily for 6 months or a lot of is termed as a chronic daily headache.
Primary stabbing headaches
Primary stabbing headaches are generally referred to as ‘icepick headaches’ or ‘idiopathic stabbing headache.’ The term ‘idiopathic’ is used by doctors for anything that comes without a cause. These are short, stabbing headaches that are terribly fast and severe. They often occur in or simply behind the ear and are quite scary.
Trigeminal Neuralgia
Trigeminal neuralgia causes pains – primarily on the face. These incorporate extraordinarily short bursts of electrical shock-like pain within the facial area – in the space of the eyes, nose, scalp, forehead, jaws, and/or lips. Sometimes one-sided and is a lot of common in folks over the age of fifty.
Hypertension, also called high blood pressure, is caused by the pressure due to excessive pumping of the heart. It is one of the leading causes of death in the world today. In addition to being a deadly condition, hypertension can also cause damage to vital organs like the liver, brains, kidneys and the heart. Unfortunately, people suffering from hypertension may not even be aware of that condition till it becomes too serious a problem. Blood pressure measure always has two readings, one taken when the heart is beating and the other when the heart is at rest. The normal values for these two readings are 140 and 90 respectively. In a long term it increases the risk of associated cardiovascular (heart) diseases such as stroke, myocardial infarction, failure of kidneys or heart, other vascular complications.
Normal pressure of blood according to current guidelines is < 130 and < 85. In hypertension the treatment is influenced by the presence of other risk factors such as pre-existing heart diseases and diabetes.
A list of the hypertension ranges from normal to risk levels are given in the table below;
| Category | Optimal | Normal | Borderline | Mild hypertension | Moderate
Hypertension |
Severe
Hypertension |
Isolated systolic hypertension |
| Systolic (mm Hg) | <120 | <130 | 130-139 | 140-159 | 160-179 | ≥180 | ≥140 |
| Diastolic (mm Hg) | <80 | <85 | 85-89 | 90-99 | 100-109 | ≥110 | <90 |
The heart supplies oxygenated or pure blood to all parts of the body through the help of vessels called arteries. The force with which the blood pushes against the walls of the artery is known as BP.
The heart pumps blood into the arteries as it is beating. The pressure exerted on the artery walls when it is being filled with blood is known as systolic pressure and is 120 normally.
The heart relaxes between the beats or pumping the blood into the arteries. This is the time when the pressure falls and is known as diastolic pressure. The diastolic pressure is normally 80.
Majority (about 95%) of patients have essential hypertension or primary hypertension. The main reasons behind this hypertension are known to be:
Remaining percentage of population has secondary hypertension which is caused as a result of underlying diseases. This is known as secondary hypertension and it has a cause which can be essentially treated. These are:
What are the symptoms of hypertension?
Sometimes the person with high BP can go for years without showing any outwardly symptoms. Therefore, it is important that people go for regular check-ups to avoid complications later on. The symptoms if at all present are;
What are the target organs affected?
The target organs that are prone to be damaged as a result of prehypertension and systemic hypertension are kidney, other cardiovascular organs, and brain & retina. Various diseases that can be caused as a result of chronic hypertension are chronic kidney disease, myocardial infarction, congestive heart failure, dementia, stroke, ventricular tachycardia and fibrillation.
What are the associated risks of Hypertension?
As is always the case, prevention is better than cure. So, one must implement a regular exercise and controlled diet plan in order to lead a healthy and prosperous life.
An arteriovenous fistula, or AVF, is a vessel that is formed by joining a vein to an artery in your arm during an operation to form an accessible blood vessel that gives increased flow of blood that are adequate for dialysis. The process of joining the vein to artery allows for an increase in the size of the vein as well as the flow in it, and this segment of the vein is called the ‘fistula’.
To carry out dialysis two needles are inserted into the fistula and after dialysis, the needles are removed. A fistula is the best vascular access for dialysis because it tends to have fewer problems and last longer than other types of dialysis access.
There are several things you should do to protect your fistula. Fistula is often called your ’lifeline’ because it is so important in enabling a good dialysis.
Although a fistula is the best sort of access and is least likely to develop problems, you do need to be aware of problems that can occur so they can be acted upon quickly: –
Another bleeding that you should look out for is blood oozing around your needles often on dialysis. Bleeding after dialysis or oozing slightly from your fistula at other times can mean that your vessel has narrowed and is increasing the pressure within the vessel. This may also cause a raised venous pressure reading on your dialysis machine; your nurses will explain where to look for this. Sometimes, the bleeding may be related to any ‘’blood thinning’’ medication that you may be taking, such as warfarin. If you notice any of these signs please let your nurses and doctor know so they can investigate. Most problems of this nature can be resolved to ensure your fistula keeps healthy.
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A menstrual cycle is termed as irregular when the normal 28 days +/- 7 days cycle is disrupted.
Menstrual cycles are called irregular if: –
Examples of menstrual problems include: –
Menstrual cycle may be affected by numerous conditions. Hormonal imbalances are usually the commonest reason for irregular menses. Changes in oestrogen and progesterone can lead to fluctuations in the regular menstrual periods. Common conditions that can disturb menstrual cycle are:
Diagnosis is usually made by conducting blood investigations including hormonal screening along with some radiological tests.
Treatment primarily depends on the exact cause of the disease. Hormonal replacement therapy, change of contraceptive pills, or certain surgical procedures might be the treatment of choice depending upon the diagnosis.
A woman is considered to have attained menopause after a year of having no menstrual bleeding. Any form of bleeding, even slight spotting following a gap of one year is termed as postmenopausal bleeding. A woman must consult a doctor if she experiences any amount of vaginal bleeding following menopause. Bleeding after menopause is rarely cause for concern but it does need to be investigated, however, because in very few cases it will be an indicator of something more serious.
There are multiple conditions that can lead to a postmenopausal bleeding. Some common causes are:
Diagnosis is usually made after a complete physical examination and proper reviewing of medical history. Important tests that might be advised include
Treatment will depend on the exact cause of the bleeding.
Hysterectomy is a surgical procedure which means removal of uterus. A woman may be advised Hysterectomy for multiple reasons like uterine fibroid, uterine cancer, prolapse of the uterus, chronic pelvic inflammatory disease, chronic pelvic pain, adenomyosis, dysfunctional uterine bleeding and so on. With the exception of cancer, hysterectomy is usually not recommended unless all other treatment methods have failed. In some cases, the gynaecologist may advice removal of fallopian tubes and ovaries simultaneously with the uterus. This is called as Hysterectomy with bilateral salpingo-oopherectomy. Depending upon the diagnosis, the gynaecologist might decide to remove the whole of the uterus or some part of it only. Your uterus might be removed from the upper part only, keeping the cervix intact, this is a partial hysterectomy or subtotal hysterectomy. In a total hysterectomy, the uterus is removed along with the cervix. A radical hysterectomy will include removal of the uterus with cervix, and some surrounding tissues, this approach is taken in case of uterine or cervical cancer.
Depending upon the type of hysterectomy to be done and the diagnosis, different approaches for the surgery may be followed, the time for healing and scar formation might vary accordingly. In an abdominal hysterectomy or an open hysterectomy, the surgeon will make a 5 to 7-inch incision along the uterine region and remove the uterus. This will eventually lead to a scar formation and will require a two to three days of post-operative hospitalization for healing.
A minimally invasive hysterectomy can be done in different manners, for example in a vaginal hysterectomy, an incision will be made in the vagina and the uterus will be removed through that. This will not leave any scar at the site.
A laparoscopic hysterectomy is done with an incision through the abdomen and removing the uterus through those incisions. Assisted vaginal hysterectomy is performed where a laparoscope is inserted through minor incisions on the abdomen, but the uterus is removed through the vagina eventually. In a robotic hysterectomy, on the other hand, a robot is used to perform the procedure and assist the surgeon.
As the name of the procedure suggests, a minimally invasive surgery has very minor incisions and have a lesser duration of hospital stay, lesser chances of infection and scarring when compared to an open abdominal surgery. In a minimally invasive procedure, a female might resume her normal daily activities within 1-2 weeks whereas, a female who has undergone an open or abdominal hysterectomy will take about 4 to 6 weeks for healing and resuming back to her normal life.
Although, minimally invasive procedure has lot of benefits over open surgery, it is not advisable for everyone to undergo the same. Pre-existing health conditions, previous abdominal surgical scars and other associated health issues may lead to deferring of a woman for a minimally invasive procedure.
Usually females who have had a hysterectomy do not develop any serious complications of surgery, however, no surgery is completely safe and does carry some risk factors. Some of those risk factors are vaginal prolapse, urinary incontinence, surgical site infection, and prolonged pain.
Females who have undergone removal of ovaries along with the uterus, they enter Menopause directly post surgery. For those who have not had their ovaries removed are likely to enter Menopause relatively sooner than the ones with an active uterus.
Women are advised to abstain from intercourse and lifting heavy weight post surgery. Women who have had their ovaries removed along with the uterus might be put on hormone replacement therapy in order to combat the drastic changes that the body might be undergoing as a result of the Menopause setting in suddenly. On the positive side, there will be substantial relief from the condition that the patient was suffering from prior to the surgery which ultimately lead to it, like heavy bleeding, bloating, chronic pain etc.
Ovulation is the period of menstrual cycle when the ovary releases eggs into the fallopian tube. If the egg gets fertilized, it leads to pregnancy and gets implanted into the uterus, a fertilised ovum is called a Zygote. If unfertilized, the endometrial lining of uterus sheds during menstruation. A good understanding of the ovulation cycle can help in planning a pregnancy and can simultaneously help in diagnosing certain disease conditions.
Usually a female ovulates on the 14th day of the menstrual cycle, provided she has a 28 days’ cycle. However, this is not the standard thumb rule for everyone. Having a varied length of menstrual cycle can interfere with the ovulation cycle. In general, ovulation occurs +/- 4 days from the midpoint of the menstrual cycle.
Ovulation involves action of multiple hormones. The follicle stimulating hormone or FSH helps maturing and eventually release of egg. It acts from 6 to 14 days of the cycle. Then comes the role of the luteinizing hormone or LH. This hormone reaches its surge level and leads to release of the egg. When the body experiences a surge in the LH hormone, the ovary starts the ovulation process, and this typically happens within few hours of the surge.
Some women may not notice any symptoms during ovulation. However, some may experience some amount of transparent vaginal discharge, pain in lower abdomen or back, slight bleeding, tenderness of the breast and increased sexual desires.
It is not necessary that one will get pregnant if she has intercourse on the day of ovulation only as the sperm can remain active in the reproductive tract for about 24 -48 hours in an ideal condition. If a woman has intercourse prior to her ovulation within few days prior to ovulation she can still get pregnant following ovulation. The egg usually has a lifespan of about only few hours.
Women can track their ovulation cycle by some hormonal tests and an ultrasound of the lower abdomen, mainly the ovarian region. Various ways of tracking the ovulation cycle can be followed at the comfort of home; recording basal body temperature throughout the menstrual cycle can help in giving you an idea of your ovulation time. Usually females have an elevated temperature during ovulation. An elevated temperature for 3 days continuously points towards ovulation. Availability of ovulation predictor kits have made it easier to predict the ovulation period. These kits detect the increase in luteinizing hormone in the urine, a dark line on the ovulation predictor kit indicates the possibility of ovulation within the next two days.
For those trying to conceive, having intercourse two days prior and on the day of ovulation can help in getting an egg fertilized. People not planning a pregnancy must use contraceptives few days prior to and after ovulation.
Gall bladder is an organ in the upper right quadrant of the abdomen which stores bile produced by the liver. Surgical removal of this organ is called as cholecystectomy. It is a very commonly performed surgery carrying very low risk of complications. Nowadays, most cholecystectomy surgeries are performed with the help of laparoscope by making a few small incisions on the abdomen. Some cases might require a more extensive approach where a larger incision is required to remove the gall bladder, that is then called as open cholecystectomy.
The commonest reason for performing a cholecystectomy is gall stones formation called as, cholelithiasis, and its related complications like pancreatitis, cholecystitis or obstruction of the bile duct due to gall stones (choledocholithiasis).
Complications following a cholecystectomy are rare, however, the below mentioned may develop in some cases:
The chances of a patient developing cholecystectomy depends on the reason for the surgery and overall health condition of the patient.
In a laparoscopic cholecystectomy, small keyhole incisions are made on the abdominal wall and a tube containing a camera will be inserted through them. The visuals will be seen on the monitor and the doctor will perform the procedure accordingly. Following that, the incisions will be sutured and the patient will be shifted to the recovery area. The procedure is usually completed within 1-2 hours.
In some cases, open cholecystectomy may be required depending on the patient’s condition. An ongoing laparoscopic procedure might have to get converted into an open procedure due to previous surgical scar tissues or other complications.
In an open cholecystectomy, an incision is made below the ribs in the right upper abdomen, the tissues and muscles are retracted and the gall bladder is removed. The site is sutured, and patient is shifted to recovery.
Depending upon the type of procedure, the time required for recovery may vary. In a laparoscopic procedure, one may be discharged the same day or at the most the next day if things continue to be normal. Complete recovery may take about a week’s time.
An open cholecystectomy might require a 2-3 days of hospitalization and almost 4 to 6 weeks for a complete recovery.
This procedure can provide relief from the discomfort and pain of a gall stone. Dietary modifications and lifestyle changes cannot treat gall stones as such. Pain medications might give a temporary relief but the pain will recur eventually. Usually, cholecystectomy does not interfere with digestion.
